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Objectives: Non-Communicable Diseases (NCDs) are the largest and fastest growing threat to human health. Iran's Ministry of Health and Medical Education (MoHME) established the Iranian Non-Communicable Diseases Committee (INCDC) in 2015 to tackle the high burden of NCDs. In line with the WHO's Global Action Plan, the INCDC developed "The National Action Plan for Prevention and Control of NCDs" and the related risk factors in Iran, 2015–2025", which was then revised to cover until 2030. Methods: In this policy synthesis study, we conducted a content analysis of upstream and other policy documents related to NCDs and relevant risk factors in Iran. Results: We used multiple streams model to illustrate the proactive approach that led to development of the national action plan. Conclusions: While countries are accelerating their efforts to reach SDG 3.4, Iran's pathway, as a WHO fast track country, will help, we envisage, other countries to scale up their active efforts to move steps forward to tackle the ever- highest burden of NCDs in their own settings. [ABSTRACT FROM AUTHOR]

Background: Road traffic injuries are the eighth leading cause of deaths in all ages. Considering the fact that driving is a social context with different rules and behaviours, the present study was aimed to explore the patterns of gender-based driving behaviours focusing on women driving in the context of Iran. Methods: Through a conventional content analysis, overall, 30 participants with different social and educational levels were recruited. A purposeful sampling method was used in which 7 males and 23 females were included because of sample triangulation. Data were collected using in-depth semi-structured interviews and analysed through inductive content analysis. Results: Overall, three main categories and 10 subcategories were extracted from the data including unsafe risky behaviours against female drivers (subcategories of scary behaviours, aggression and violence against female drivers, ignoring women and revenge-based behaviours), protective and friendly behaviours (helping and caring for women drivers, respecting women drivers, being patient for women driving subcategories) and specific driving behaviours of women (preventive and cautious behaviours, driving based on traffic rules and cultural characteristics subcategories). Conclusion: Different patterns of driving behaviors focused on female drivers were found in the present research. Reducing the aggressive gender-based driving behaviors against female drivers and strengthening the protective behaviors for women can be achieved through establishing appropriate rules and public education. Further research is required to explore the process of gender-based driving behaviours, as well as identifying different consequences of such behaviours on communities. [ABSTRACT FROM AUTHOR]

Background: Myonectin (CTRP15), a recently identified myokine, plays a crucial role in regulating glucose metabolism. Objectives: This study aimed to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on serum myonectin levels, using matched training volumes for both interventions. Methods: Twenty-four male Wistar rats, aged 18 to 20 weeks, were randomly assigned to three groups of eight: Control, MICT, and HIIT. The training groups participated in HIIT and MICT programs (three days per week) on a treadmill for eight weeks. Measurements included serum glucose, insulin, myonectin, and the homeostasis model assessment of insulin resistance (HOMA-IR). Additionally, the weight of the Flexor hallucis longus (FHL), gastrocnemius muscles, and epididymal and retroperitoneal fat pads was recorded. Results: Both HIIT and MICT significantly reduced weight gain and fat mass (epididymal and retroperitoneal) compared to the control group (P < 0.05). Eight weeks of HIIT significantly decreased serum insulin levels and HOMA-IR compared to both the control and MICT groups (P < 0.05). No significant differences in serum myonectin levels were observed between the groups. Conclusions: This study suggests that HIIT is more effective than MICT in improving metabolic status in rats, though it does not significantly affect serum myonectin levels. [ABSTRACT FROM AUTHOR]

Vaspin is an adipocytokine with insulin-sensitizing and anti-inflammatory traits. The purpose of this study was to evaluate the effect of high-intensity interval training (HIIT) on serum, visceral and subcutaneous adipose tissue vaspin levels in rats exposed to a diet high in fat and sugar (HFS). Thirty-two male Wistar rats were randomly divided into HFS and standard diet (SD) groups. After 12 weeks, each group was divided into sedentary and HIIT groups. HIIT program was performed 3 times/week for 8 weeks. Retroperitoneal adipose tissue, inguinal adipose tissue and serum were collected to analyze vaspin levels. Also, serum glucose and insulin levels, insulin resistance index (HOMA-IR) and retroperitoneal and inguinal fat weights were measured. HFS significantly increased weight gain, weight of inguinal (p=0.001) and retroperitoneal fat depots (p<0.001), serum glucose levels (p<0.001) and HOMA-IR (p<0.001). The HIIT was able to decline weight gain and fat mass (p<0.05) but did not affect inguinal and retroperitoneal fat depots' vaspin levels. Eight weeks' HIIT significantly increased serum vaspin (p=0.002) and decreased insulin (p=0.001) levels only in rats fed with SD. Although the HIIT program can cause significantly reducing effects on weight gain and fat depots' weights, it does not effect on circulating and fat depots' vaspin levels in rats fed an HFS. [ABSTRACT FROM AUTHOR]

To assess the impact of parental asthma on risk of pre-term birth (PTB) and intrauterine growth restriction, and their subsequent association with childhood asthma. Three sequential cross-sectional surveys were conducted in 1993 (3,746), 1998 (1,964) and 2006 (1,074) in the same 15 schools among 5-11 year old children in Merseyside using the same respiratory health questionnaire completed by parents (sample size in brackets). Between 1993 and 2006, prevalence of PTB varied between 12.4 and 15.2%, and of small for gestational age (SGA or growth restricted) babies between 2.1 and 4.6%, and maternal asthma prevalence between 8.1 and 13.4%. For the combined surveys mothers with asthma were more likely to have a PTB than non-asthmatic mothers (OR 1.39, 95% CI 1.10-1.95, p < 0.001), and in the 2006 survey were more likely to have an SGA baby. 40.9% of PTBs of asthmatic mothers developed doctor diagnosed asthma compared to 34.3% for term babies (adjusted OR 1.65, 1.34-2.04, p < 0.001). The corresponding estimates for the symptom triad of cough, wheeze and breathlessness were 19.4 and 17.6% (adjusted OR 1.78, 0.79-3.98). Conversely SGA babies were less likely to develop doctor diagnosed asthma (adjusted OR 0.49, 0.27-0.90, p < 0.021), or the symptom triad of cough, wheeze and breathlessness (adjusted OR 0.22, 0.05-0.97, p < 0.043), whether or not the mother was asthmatic. Maternal asthma is an independent risk factor for PTB which predisposes to childhood asthma. Intrauterine growth restriction was protective against childhood asthma. Keywords Asthma * Pre-term birth * Small for gestational age * Maternal asthma * Smoking * Children, Introduction Previous studies evaluating the relationship between parental asthma, birth outcomes and prevalence of asthma in children have shown inconsistent and weak associations [1-3] and have not evaluated the extent [...]

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p = 5.4, 95% CI = 5.1–5.7) and encopresis (p = 0.13, 95% CI = 0.09–0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p = 11, 95% CI = 9.5–12.7) and Separation Anxiety (p = 10.6, 95% CI = 9.1–12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6–18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6–18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS—PL). In this study, 54 children aged 6–9 years (0.58%, CI 0.47–0.77), 64 adolescents aged 10–14 years (0.57%, CI 0.47–0.77), and 117 adolescents aged 15–18 years (1.22%, CI 0.96–1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50–61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68–38.56), tobacco use (20.43%, CI 15.77–26.04), and depressive disorders (18.30%, CI 13.88–23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents. Method: We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia‐present and lifetime version (K‐SADS‐PL) semi‐structured face‐to‐face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data. Results: Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81–1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge‐eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive–compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders. Discussion: Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge‐eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors. [ABSTRACT FROM AUTHOR]

Background: Among Middle East countries, the prevalence of Metabolic Syndrome (MetS) and Type 2 Diabetes Mellitus (T2DM) dramatically increased in Iran. Very few evidence-based studies have been performed on the relationship between metabolic disorders and colorectal cancer (CRC) in developing countries at least in Iran. Objectives: This case-control study aimed to determine the relationship between MetS and CRC risk. Methods: A case-control study with 414 participants (207 cases and 207 controls) was conducted among referral hospitals (Imam Reza, Shahid Madani, and Sina) in Tabriz, Azerbaijan province, Iran. Cases with CRC confirmed by positive pathology and colonoscopy findings were selected and compared with the controls without neoplastic and chronic diseases at the same time and hospitals for the cases. Group matching was used based on sex and age variables for the case and control groups. MetS was defined by the International Diabetes Federation (IDF) criteria. Multiple logistic regression was used to estimate adjusted odds ratios for the association between MetS and odds of CRC. Results: Out of 414 participants, 220 (53%) were men. Among the cases, 134 (64.73%) patients had MetS, while in the control group, 82 individuals (39.61) had MetS history. After adjusting for the confounders, MetS andDMhistory were significantly associated with elevated odds of CRC (OR: 2.79, %95 CI: 1.58 - 5.15, P = 0.001) and (OR: 2.57, %95 CI: 1.25 - 4.58, P = 0.006), respectively. We have observed also a dose-response relation and a trend between the components of MetS and CRC risk. So, the odds of CRC increased by rising numbers of MetS components. Conclusions: It seems that MetS and its components are associated with an increased risk of CRC. [ABSTRACT FROM AUTHOR]

Background and Objective: Knee osteoarthritis is one of the most common rheumatologic problems. To investigate risk factors related to the knee osteoarthritis a case-control study was performed using cases diagnosed in the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study, stage I. Methods: Using data from the 2012 COPCORD study, stage-I that was conducted in Sanandaj, northwestern of Iran, we runned a case-control study in 2014-2015. Cases were 700 knee osteoarthritis using American College of Rheumatology (ACR) criteria, frequency matched with 700 healthy controls that were randomly selected from the general population. Results: In multivariate analysis, statistical significant relation was observed between knee OA and some studied factors such as body mass index (P <0.001), lodging (living in highland vs. plain) (P <0.001), type of used toilet (regular vs. toilet) (P <0.001), history of using high-heeled shoes (>3 cm) (P = 0.005), history of knee Injury (P = 0.04), history of lower limb fracture (P = 0.02), Number of pregnancies (P <0.001) and history of pain and swelling (lasting for one months) (P = 0.04). Conclusions: Living in highland area, using regular toilet, having knee injury and lower limb fracture in the past were most significant associated factors with occurrence of knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Introduction: The large portion of burden of diseases, especially in the developing countries is attributed to hypertension. Identification of the potential risk factors of hypertension is essential for disease management. In this study we investigated the role of socio-economic inequality in the prevalence of hypertension in Ilam Province. Methods: Totally, 690 individuals aged over 15 were enrolled in this cross-sectional study, through systematic random sampling from March 1 to October 30, 2017. Socio-economic status (SES) score was calculated by 7 variables including; age, sex, job, marital status, educational level, and economic status, residency, then, it was divided to five levels. Concentration index was used to estimate the inequality in hypertension. To estimate the percentage contribution in final step elasticity divided to concentration index for each contributor and contributions to inequality is estimated. Results: The concentration index for hypertension was -0.154 95% CI (-0.02, -0.23), therefore hypertension was more prevalent in lower socioeconomic groups. The important socioeconomic contributors in inequality were job (P =0.008), educational level (P =0.005), and SES (P =0.003). According to concentration index decomposition, the main sources of inequality in hypertension were job (15%), educational level (18%), and SES (21%), respectively. Conclusion: Hypertension is more prevalent in lower SES groups and the job, education, and SES are important contributory factors of inequality. One substantial key point to achieve an effectiveness approach to deal with chronic diseases might be building partnership with disadvantaged populations. [ABSTRACT FROM AUTHOR]

Background: The risk factors for infection with leptospirosis in Iran have never been studied. We aimed to determine the risk factors of leptospirosis and the epidemiological pattern of this disease in Golestan Province, Iran during 2011-2017. Study design: A case-control study. Methods: This case-control study was performed on the population of patients diagnosed with leptospirosis. Controls were selected from the residents of Golestan province, northern Iran and were matched with the cases for gender, age group, and place of residence. After coding the data collected in checklists, the analysis was performed in SPSS using independent t-test, logistic regression, contingency tables, and Fisher exact test. Results: Eighty-seven cases were diagnosed infected with leptospirosis. Most patients were male (69.0%) and residents of rural areas (82.7%). The three leading risk factors for leptospirosis were exposure to stagnant rice paddy water while having a skin scratch/injury (OR=11.21, 95% CI: 3.02, 43.06), washing the face with stagnant rice paddy water (OR=11.33, 95% CI: 5.12, 25.01), and sighting of rats or rat nest in rice paddies (OR=3.30, 95% CI: 1.01, 11.62). Conclusion: For farmers working in stagnant and muddy waters of rice paddies, occupational protection measures such as wearing waterproof boots, gloves, support, and socks can reduce the chance of infection with leptospirosis. Health education of the people with susceptible occupations about the transmission and prevention methods can also play a key role in controlling this disease. [ABSTRACT FROM AUTHOR]

Background: Smoking is preventable factor for pregnancy outcomes such as low birth weight (LBW). In this study, we assessed the effects of smoking cessation in pregnancy period on the birth weight in Randomized Controlled Trial studies (RCTs). Methods: International databases of Pub Med, Scopus, and Web of Science, by the MeSH heading and/or additional terms, were searched to assess relevant studies in systematic possess. I2 statistics was used to assess of heterogeneity. Pooled effects size was obtained by random effects model. Meta-regression was used to explore of heterogeneity using Stata software version 12 (Stata Corp, College Station, TX). Results: A total 16 RCTs, 6192 women were enrolled to assess of smoking cessation in pregnancy period on the birth weight. Relative risk (RR) of not smoking at the end of pregnancy in intervention group was 2.47 (95% CI: 1.73-3.20). The odds ratio (OR) for effect of smoking cessation on LBW was 0.65 (95% CI: 0.42-0.88) and standardized mean difference (SMD) was significantly increased in the intervention group, 0.28 (95% CI: 0.05-0.50). Conclusions: Results of this study approve results of previous RCTs that smoking cessation in pregnancy is a good practical action to prevention of LBW in infants. [ABSTRACT FROM AUTHOR]

BACKGROUND Infertility among couples is a painful emotional problem, which results in the feeling of grief in the form of psychological problems such as depression and anxiety. The present study was aimed to survey the frequency of depression and anxiety levels of infertile women in western Iran in 2017. METHODS This cross-sectional study used a simple random sampling method for selecting the sample. The study population consisted of all infertile women who went to Farhangian health center in Ilam. The Beck's Depression Inventory, Beck's Anxiety Inventory, and demographic characteristics questionnaire were used for collecting the data. The questionnaires were distributed among midwife experts and patients. The collected data were analyzed by the chi-square test and variance analysis using SPSS version 20. RESULTS Among 200 infertile women, 53.5%, 32%, 11%, and 3.5% suffered from severe, moderate, mild, and no anxiety, respectively. However, there were 85.5% showing a clinical anxiety. In addition, 42%, 19.5%, 14.5%, and 24% suffered from severe, moderate, mild, and no depression, respectively. However, there were only 61.5% showing a clinical depression. Women who had a lower than diploma education level and primary infertility suffered from higher anxiety levels. CONCLUSIONS There was a high level of anxiety and depression in infertile women; therefore, it is necessary to pay attention to these disorders in the process of treatment of infertile women. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is an autoimmune disease associated with inflammation of the central nervous system in humans. This disease is the most common neurological disease, especially in young people. Various factors, including biological, genetic, and environmental factors, are effective on the prevalence of MS disease. This study intends to determine the relationship between geographical factors, and the prevalence of MS disease was performed. Methods: This ecological study was carried out on 2000 patients with diagnosis of MS during the years 2001-2014 in Isfahan province. All patients' data including age, sex, marital status, year, and location of patients were extracted from the files. Arc geographic information systems version 10.3 software was used for geographical maps, and for statistical analysis of data, SPSS.16 software ANOVA tests, independent t-test, and Kruskal--Wallis were used. Results: Based on recorded cases of MS, the highest and lowest cumulative incidence of diseases was related to the city of Isfahan (75.92 in one hundred thousand) and Aran Bidgol (1.16 in one hundred thousand), respectively. A significant relationship was observed between the incidence and height above sea level (P = 0.001), the average annual rainfall (P = 0.001), and land use (P = 0.001). With increase in the height above sea level and the average annual precipitation, the incidence of disease decreased. Conclusions: MS disease incidence is high in Isfahan province. The distribution of the disease is not the same in the cities of this province, and some cities have a higher incidence. Furthermore, the incidence of the disease is influenced by geographical factors such as height above sea level, average annual rainfall, and land use. Therefore, it is recommended that relevant authorities by the implementation of screening programs in high-risk areas take action to identify and treat patients in the early stages. [ABSTRACT FROM AUTHOR]

Introduction: Occupational stress and job satisfaction in nursing are issues that affect job performance and the quality of care provided by nurses. Aim: The aim of this study was to assess occupational stress, job satisfaction and job performance and how they are influenced by personal and work characteristics among hospital nurses in Ilam, Iran in 2013. Materials and Methods: In this descriptive cross-sectional study the sample included all nurses working in teaching hospitals in Ilam. All of the participants were chosen by census sampling method. The total number of nurses according to the inclusion criteria were 208, out of which 198 nurses completed the questionnaire. Study tools included Harris's Nurse Stress Index (NSI), Spector's Job Satisfaction Survey (JSS), Schwirian Six Dimension Scale of Nursing Performance (6-DSNP) and also a demographic questionnaire. Data were analysed using descriptive and inferential statistics such as ANOVA and Pearson correlation coefficient at the level of significance <0.05. Results: The mean of occupational stress and job satisfaction of nurses was moderate and the mean job performance was at a high level. In this study, there was a significant relationship between occupational stress and job satisfaction (p=0.001) and also occupational stress and job performance (p=0.04). There was no significant relationship between job satisfaction and job performance. Conclusion: The results of this study show the importance of nurses' occupational stress on their job satisfaction and performance.In addition, the demographic variables were influential on the main variables in this study. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) as a musculoskeletal disorder is one of the most common occupational injuries in nurses but there isn't any valid measure of the prevalence of LBP in Iranian nursing. In order to increase the power and improve the estimates of the prevalence of LBP in Iranian nurses, a comprehensive meta-analysis was carried out. A summary measure of all studies conducted in this field was found and distributions of LBP were evaluated based on different variables. Methods: Inclusion criteria included articles with prevalence of LBP in Iranian nurses, who had at least six months of work experience without any trauma, injuries to spine, or any underlying disease. The keywords"prevalence, low back pain, nurses", and "Iran" were used as part of this search. Databases such as Pubmed, Web of Science, Science direct, Scopus, IranMedex, Irandoc, Magiran, SID, CIVILICA, IMEMR and Google scholar were searched up to and including 15 June 2016. For data extraction a form was designed that included the following variables: Author names, province, sample size, age, gender, marital status, work experience, body mass index, job type, smoking status, work schedule, year of publication, type of standard questionnaire, prevalence of LBP, studies' quality score and climate classifications. Data analysis was carried out using fixed and random effects model. Heterogeneity between studies was assessed by using the I2 and Q tests. Results: In all 1250 articles were identified and 22 articles with 9347 participants met the inclusion criteria for metaanalyses after filtering. The prevalence of low back pain during their working life and during the last year, was estimated at 63% (95% Confidence Interval (CI): 57.4-68.5) and 61.2% (95% CI: 55.7-66.7) respectively. The prevalence rate of this disorder was 58.7% (95% CI: 35.8-81.7) and 60.4% (95% CI: 52.2-68.6) among men and women respectively. Furthermore, prevalence's of LBP were 59.5% in wards nurses, 50.3% in operating room technicians, and 39.4% in aid nurses. Conclusions: The results showed the high prevalence of LBP injury in nurses, especially female nurses. The effect of musculoskeletal disorders such as LBP may be reduced by considering proper observation of the principles of ergonomics in the workplace, performing physical examinations on a regular basis, identifying risk factors in the advancement of musculoskeletal disorders and then trying to fix them. [ABSTRACT FROM AUTHOR]